Docusate

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Docusate
Docusate2DCSD.svg
Docusate sodium
Names
Trade namesColace, Ex-Lax Stool Softener, others
Clinical data
Drug classStool softener
Pregnancy
category
  • US: C (Risk not ruled out)[1]
Routes of
use
By mouth or rectally
Onset of action12 hrs to 5 days[2]
Duration of action3 days[2]
Defined daily dose0.15 g (by mouth)[3]
External links
AHFS/Drugs.comMonograph
MedlinePlusa601113
Legal
License data
Legal status
Chemical and physical data
FormulaC20H37NaO7S
Molar mass444.56 g·mol−1
3D model (JSmol)
Density1.1 g/cm3
Melting point153 to 157 °C (307 to 315 °F)
Solubility in water1 in 70 parts mg/mL (20 °C)

Docusate, also known as docusate salts or dioctyl sulfosuccinate,[4] is a laxative of the stool softener type used to treat constipation.[2] It is considered a good choice in children who have hard feces.[2] Use for constipation, however, is poorly supported by evidence.[5][6] It may be taken by mouth or used rectally.[2] By mouth a bowel movement often occurs in 1 to 3 days,[2] while rectal use may be effective within 20 minutes.[7]

Side effects are uncommon.[2] Rarely, there may be abdominal cramps or diarrhea.[2] Efficacy decreases with long-term use, and may cause poor bowel function.[1] Docusate is acceptable during pregnancy and breastfeeding.[8] It works by allowing more water to be absorbed by the feces.[1][9] It typically comes in the form of a sodium, calcium, or potassium salt.[2]

It is on the World Health Organization's List of Essential Medicines, the safest and most effective medicines needed in a health system.[10] It is available as a generic medication and is not very expensive.[9] In the United States, one hundred doses are about US$14.[2] The sodium salt, dioctyl sodium sulfosuccinate, also is used as a food additive, emulsifier, dispersant, and wetting agent, among other uses.[11] In 2016 it was the 127th most prescribed medication in the United States with more than 5 million prescriptions.[12]

Medical use

Constipation

Docusate is frequently used to treat constipation, and in painful anorectal conditions such as hemorrhoids and anal fissures, to help avoid pain caused by straining during bowel movements. However, the available evidence does not support its use for these purposes. Multiple studies have found docusate to be no more effective than a placebo for improving constipation.[5][6][13][14] Others have found it to be less useful for the treatment of chronic constipation than psyllium.[15]

The medication may be given to people who are receiving opioid medication, although prolonged use may cause irritation of the gastrointestinal tract. Data supporting its efficacy in treating chronic constipation are lacking.[14][16]

Other

Docusate sodium, when used with ear syringing, may help with earwax removal, particularly in the case of impaction.[17]

Docusate sodium is approved and recommended as safe during pregnancy and breastfeeding.[18]

Available forms

Docusate sodium may be given by mouth or rectally. It also is used as an emulsifier and dispersant in topical preparations. When taken by mouth it is typically recommended with plenty of water.

Dosage

The defined daily dose is 0.15 g (by mouth)[3]The typically dose in adults is 12.5 to 50 mg two to four times per day.[19]

Side effects

Side effects are typically mild and include stomach pain, diarrhea, or cramping. Serious allergic reactions may occur with the drug. The most severe side effect of docusate, although very rare, is rectal bleeding.[20]

Docusate is not recommended in people with appendicitis, acute abdomen, or ileus.[16]

Dioctyl sodium sulfosuccinate is a strong irritant for eyes and lungs, and also a skin irritant. Ingestion may cause the side effects described above, such as diarrhea, intestinal bloating, and occasionally cramping pains. Dioctyl sodium sulfosuccinate is not known to be carcinogenic, mutagenic, or teratogenic.[21]

Interactions

Docusate might increase resorption of other drugs, for example, dantron (1,8-dihydroxyanthraquinone).[16]

Chemistry

Solubility of dioctyl sodium sulfosuccinate in water is 1:70 (14 g/l) at 25 °C, increasing to 1:20 at 70 °C. Solubility is better in less polar solvents: 1:30 in ethanol, 1:1 in chloroform and diethylether, and practically unlimited in petroleum ether (25 °C). It also is highly soluble in glycerol, although this is a rather polar solvent.

The ester groups are easily cleaved under basic conditions, but are stable against acids.[16]

Docusate salts include docusate calcium, docusate sodium, and docusate potassium.[1][4]

Mechanism of action

Docusate does not stay in the gastrointestinal tract, but is absorbed into the bloodstream and excreted via the gallbladder[16] after undergoing extensive metabolism.

The effect of docusate may not necessarily be all due to its surfactant properties. Perfusion studies suggest that docusate inhibits fluid absorption or stimulates secretion in the portion of the small intestine known as the jejunum.[medical citation needed]

Society and culture

Other uses

Dioctyl sodium sulfosuccinate is used as a surfactant in a wide range of applications, often under the name Aerosol-OT. It is unusual in that it is able to form microemulsions without the use of co-surfactants, and it has a rich variety of aqueous-phase behavior including multiple liquid crystalline phases.[22]

Dioctyl sodium sulfosuccinate is approved for use in a variety of food products. It is approved for use as a surface active agent, stabilizer, thickener, wetting agent, processing aid, solubilizing agent, emulsifying agent, and dispersing agent in foods. The highest amount found in food products is 0.5% by weight, which include pasteurized cheese spreads, cream cheeses and salad dressings.[25]

The FDA determined that dioctyl sodium sulfosuccinate is generally recognized as safe (GRAS) for use as wetting agents or solubilizers for flavor emulsion stabilizers in carbonated and non-carbonated drinks at levels up to 10 parts per million.[26]

Brandnames

In the U.S., dioctyl sodium sulfosuccinate is available under multiple brand names: Aqualax, Calube, Colace, Colace Micro-Enema, Correctol Softgel Extra Gentle, DC-240, Dialose, Diocto, Dioctocal, Dioctosoftez, Dioctyn, Dionex, Doc-Q-Lace, Docu Soft, Docucal, Doculax, Docusoft S, DOK, DOS, Doss-Relief, DSS, Dulcolax - Stool Softener (not to be confused with another drug marketed under the Dulcolax brand, bisacodyl, which is a stimulant laxative), Ex-Lax Stool Softener, Fleet Sof-Lax, Genasoft, Kasof, Laxa-basic, Modane Soft, Octycine-100, Pedia-Lax, Preferred Plus Pharmacy Stool Softener, Regulax SS, Sulfalax Calcium, Sur-Q-Lax, Surfak Stool Softener, and Therevac-SB. Generic preparations are also available.

In the UK, dioctyl sodium sulfosuccinate is sold under the brand name Docusol (Typharm Ltd) and DulcoEase (Boehringer Ingelheim).

In Australia, dioctyl sodium sulfosuccinate is sold as Coloxyl and Coloxyl with senna.

In India, preparations include Laxatin by Alembic, Doslax by Raptakos Laboratories, Cellubril by AstraZeneca, and Laxicon by Stadmed.

Other animals

Toxicity for different species varies widely, but dioctyl sulfosuccinate biodegrades quickly in soil and water, a typical finding being >90% in 12 to 17 days. In the atmosphere, it is predicted to be removed by a photochemical reaction with an estimated half-life of 18 hours.[27]

Marine species

Dioctyl sodium sulfosuccinate has been determined to be of low toxicity for crustaceans such as the hermit crab Clibanarius erythropus and the shrimp Crangon crangon.

Toxicity for molluscs varies widely, with 48-hour LD50 found between 5 mg/l for the common limpet and 100 mg/l for the common periwinkle. Various species of phytoplankton have an LD50 around 8 mg/l.

In a 2010 study, dioctyl sodium sulfosuccinate exhibited higher toxicity against bacteria (Vibrio fischeri, Anabaena sp.) and algae (Pseudokirchneriella subcapitata) than did a number of fluorinated surfactants (PFOS, PFOA, or PFBS). Measuring bioluminescence inhibition of the bacteria and growth inhibition of the algae, the ED50 were in the range of 43–75 mg/l. Combinations of the fluorinated compounds with dioctyl sodium sulfosuccinate showed mid to highly synergistic effects in most settings, meaning that such combinations are significantly more toxic than the individual substances.[28]

Freshwater species

The substance is highly toxic for rainbow trout with a median lethal concentration (LC50) of 0.56 mg/l after 48 hours for the pure substance. It is only slightly to moderately toxic for rainbow trout fingerlings, and slightly toxic for harlequin rasboras (LC50 27 mg/l of a 60% formulation after 48 hours).

References

  1. 1.0 1.1 1.2 1.3 2013 Nurse's Drug Handbook. Burlington, MA: Jones & Bartlett Learning. 2013. p. 366. ISBN 9781449642846.
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 "Docusate Salts". The American Society of Health-System Pharmacists. Archived from the original on 23 September 2015. Retrieved 11 August 2015.
  3. 3.0 3.1 "WHOCC - ATC/DDD Index". www.whocc.no. Retrieved 22 September 2020.
  4. 4.0 4.1 American Society of Health-System Pharmacists (15 August 2011). "Stool Softeners". Archived from the original on 5 September 2015.
  5. 5.0 5.1 Fakheri, RJ; Volpicelli, FM (February 2019). "Things We Do for No Reason: Prescribing Docusate for Constipation in Hospitalized Adults". Journal of Hospital Medicine. 14 (2): 110–13. doi:10.12788/jhm.3124. PMID 30785419.
  6. 6.0 6.1 Canadian Agency for Drugs and Technologies in Health (26 June 2014). "Dioctyl Sulfosuccinate or Docusate (Calcium or Sodium) for the Prevention or Management of Constipation: A Review of the Clinical Effectiveness". CADTH Rapid Response Reports. PMID 25520993.
  7. "Docusate sodium". 18 December 2004. Retrieved 6 March 2019.
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  14. 14.0 14.1 Ramkumar, D; Rao, SS (April 2005). "Efficacy and safety of traditional medical therapies for chronic constipation: systematic review". American Journal of Gastroenterology. 100 (4): 936–71. doi:10.1111/j.1572-0241.2005.40925.x. PMID 15784043.
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External links

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